Reconstruction of the hypospadiac hooded prepuce

The role of foreskin reconstruction as part of distal hypospadias repair remains uncertain. Thus, we wished to define better the indications with a view to improving the success of this cosmetic alternative. We reviewed the outcome in a group of patients who underwent foreskin reconstruction to highlight the criteria for likely success.

The records of 51 boys who underwent foreskin reconstruction from 1996 to 2001 were reviewed from a total hypospadias repair group of 223. Boys who underwent foreskin reconstruction were 4 months to 9 years old (median age 9.3 months). Surgery included a meatal advancement and glanuloplasty procedure in 22 patients, Mathieu urethroplasty in 2, King-Duplay repair in 2 and a meatotomy in 1, while in 24 with a normal glans meatus foreskin plasty was the only surgery. Cases in which the foreskin was required for chordee release and those in which the gap between the ventral aspects of the foreskin was wide were excluded from foreskin reconstruction. Also, patients were selected by intraoperative assessment of the ability to approximate the foreskin in the midline at the level of the coronal groove. If this maneuver can be performed without placing the foreskin under tension, the foreskin is considered suitable for reconstruction. All patients received regional and general anesthesia plus intraoperative antibiotics. After suitable urethroplasty the technique of foreskin reconstruction was generally similar for all types of the condition.

The result was excellent in 36 patients (70.6%) with a normal-appearing foreskin that retracted easily. There was a good result in 8 patients (15.7%) with a satisfactory meatus at the tip of the glans and a retractable foreskin but minor foreskin deformity. Only 3 patients had a minor complication, including a fistula through the prepuce in 2 and wound infection in 1. No boy had a complication due to urethroplasty and there were no urethral fistulas.

Our study shows that foreskin reconstruction is successful, particularly if the proximal, coronal groove portion of the prepuce can be easily approximated manually and the procedure can be combined with a range of distal repairs. We would recommend reconstruction of the prepuce if parents would prefer their son to be uncircumcised, providing that the foreskin is suitable for preservation.